Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01280 | Date 02/11/2018 |
| Token No | SM/18-19/1763 02/11/2018 | Serial | 015 |
| Patient Name | Miss BHUMI KUMARI RAO | Contact No | NOT GIVEN |
| Address | 4 DEY GHAT LANE | Age | 12 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||